Let’s face it. The concept isn’t new.
For years, many of us have been part of conversations about the need to remove silos, break out of old, isolated patterns of behavior and find new partnerships that might hope to solve intractable problems and emerging issues. We’ve discussed the most in-vogue concepts for framing, facilitating and even forcing these types of cross agency or public private solutions to occur. We’ve all been part of attempts at these solutions that ended in half measures or outright failure.
But even as we understand this track record, we also find ourselves in a pretty unique moment that calls for us to try again. Here’s what we know now about our new reality:
- The pandemic changed the experience of administering a government agency forever. For some it swelled the numbers we serve, as it did with Medicaid. For others it shrank their roles in ways that indicate larger problems for communities across the country, particularly those that had already been historically underserved.
- Staffing issues aren’t going away. The great resignation, the quiet quitting and a host of other changes to the way we recruit and retain staff across myriad government programs must change for good. We are only just beginning to understand what that means in each state and in different contexts. But leading through this moment, where multiple positions remain open and services have to be curtailed, requires a mix of white-knuckled optimism and a flair for the creative.
- The pillars of our health care delivery system are in crisis. Stretched thin by years of pandemic, many of our institutions are faltering. The challenges of our already troubled system were laid bare by the national health emergency and the individuals who work in those systems are exhausted. We have seen the end of public health as an unquestioned good. And communities often left behind or entirely unseen at all by the health care system miss the chance to live their healthiest life in even greater numbers.
As we seek to understand this new landscape and find solutions that will work in a different context, returning to time-tested strategies for cross agency and public-private partnership work might be the refuge we need. It’s good to remind ourselves in this moment that there are certain strategies that create a foundation for progress, and we know what they are:
- Don’t quit. Resist the urge to stop the process even if the last meeting ended up contentious and unresolved. Intractable problems did not become that way in one meeting and they won’t be solved in one meeting. Commit yourself and your agency to the long haul. Set realistic measures for when it is untenable to proceed but do so with a willingness to try longer than you thought you might.
- Speak the same language or get a translator. It is all too easy for people who work in the same general area of content to take for granted that they are speaking the same language. Too often, this simply isn’t true. Health care terms in particular take on very different meanings based on the place from which they originate. Don’t assume you know what a term means. Take the time to stop and clarify language. And if you find this is a sticking point, find a good facilitator – in this case acting as a translator – to help you level set and start from a common understanding from which you can build.
- Goal setting is worth the time, effort, and conflict it takes. Get crystal clear on purpose of working together. Make sure the goals actually move a needle and identify which needle each goal moves. Put real metrics to what you can accomplish. Don’t allow your effort to stay in the “let’s work together” world of vague language and even vaguer outcomes. No work alignment or any other meaningful effort can start until you have defined what you can achieve. It’s human nature to avoid specific goals and metrics. If you don’t set them, you can’t fail to meet them. But in almost any context, you can’t achieve anything unless you know what achievement looks like.
- Make sure leadership remains a verb. In the space that is cross-agency or public private partnerships, leadership must continue to be an action word. It is not a job title. In fact, in the difficult effort to redefine what it means to work together across agencies, policies, programs and people served, it will take leadership from every part of your team to create and execute the plan.
- Invite new voices to the table and make sure they have a meaningful seat. Hashing and rehashing the same ground won’t produce results. Don’t be afraid to find new voices and new ideas and invite those voices and ideas to the table. We cannot remake systems without accepting that doing it the way we have always done it is not possible.
- Know what you know. You are best positioned to contribute when you understand clearly what’s in your wheelhouse and what’s not. As yourself, what is the state positioned to contribute in this context that would add the most value? What can’t or shouldn’t we try to do as part of this partnership? You can’t force a role on yourself or a partner if they can’t fulfill that role. And insisting you can deliver what you can’t only serves to keep a better equipped partner from doing it.
These concepts and principles are not new. But they are surprisingly difficult to hold onto when you are working through a process you might have attempted multiple times before. There is no magic framework or simple one, two, or three-step process that will produce change. The elements outlined above take consistently conscious partnership and a lot of self-examination. They require you to do things differently even as you circle a problem that you’d dealt with 100 times. They ask you to consider what of your old ways of doing things you want to keep and what is better jettisoned. They expect you to stretch and grow along with the entire partnership you’ve assembled.
They are also our best hope to begin to remake, rebuild and rehabilitate our challenged systems so they can hope to meet the needs of the people they serve and fulfill their highest purpose. Even in these unpredictable times.